The indications for HRT in this review are wider than those initially
recommended by NAMS CSM and EMAS where the advice is a result of the “one
dose fits all” WHI study and the incomprehensible data collection
of the MWS. An alternative view is that hormone therapy prescribed
intelligently is safe and associated with considerable quality of life
benefits.

In Europe oestrogen has been principally given for the treatment of
climacteric symptoms and for the improvement of low bone density. The
symptoms may be due to the vaso-motor instability of hot flushes and
sweats with insomnia and tiredness or pelvic atrophy with vaginal dryness,
dyspareunia, sexual dysfunction and the urethral syndrome. (16) The
oestrogen may also be given for the prevention or the treatment of osteoporosis
in women with decreased bone density as estrogens in the appropriate
dose has an anabolic as well as an anti-catabolic effect on the skeleton.
(17)

More controversial indications would be for peri-menopausal depression
(18 19) or premenstrual syndrome, particularly in the years of the peri-menopausal
state. (20 21) Loss of energy and loss of libido in association with
climacteric symptoms are distressing for the couple and should be indications
for oestrogen sometimes with the addition of testosterone. (22)

The value of oestrogen therapy in the prevention of coronary artery
disease, Alzheimer’s disease and stroke is now controversial and
would not with current knowledge be recommended. Similarly, the belief
that oestrogens are of value in the secondary prevention of further coronary
artery disease seems no longer valid. Thus, oestrogen therapy for
prevention of these chronic cardiovascular and neurological disorders
is no longer recommended although many workers cling to the hypothesis
of a window of opportunity for prevention if oestrogen therapy is started
in the first 10 years after the menopause before irreversible arterial
and neurological degeneration has occurred. The different indications
are discussed in more detail.